Paramedic rapid sequence intubation in patients with non-traumatic coma.

Area of Science:

• Emergency Medicine
• Critical Care
• Pre-hospital Care

Background:

• Pre-hospital intubation is common for comatose patients, but optimal techniques are debated.
• Paramedic rapid sequence intubation (RSI) may benefit traumatic brain injury patients.
• The efficacy of paramedic RSI for non-traumatic coma remains unclear.

Purpose of the Study:

• To evaluate the procedural success and complications of paramedic RSI in patients with non-traumatic coma.
• To compare outcomes between younger and older patients undergoing pre-hospital RSI.

Main Methods:

• Retrospective review of paramedic patient care records from 2008-2011.
• Inclusion criteria: suspected non-traumatic coma, paramedic treatment and transport.
• Data collected: demographics, intubation conditions, vital signs, complications. Comparison of patients <60 years vs. older patients.

Main Results:

• 551 out of 1152 paramedic RSI attempts were for non-traumatic coma.
• Intubation success rate was 97.5%.
• Significant systolic blood pressure drops observed in both younger (16 mmHg) and older (20 mmHg) patients. Four patients experienced brief cardiac arrest, all successfully resuscitated.

Conclusions:

• Paramedic RSI demonstrates a high procedural success rate in non-traumatic coma patients.
• The procedure is associated with significant blood pressure reduction.
• Further research is necessary to ascertain if paramedic RSI improves patient outcomes in this population.